Director of Case Management (LVN/RN)

HMG Healthcare LLC•The Woodlands, TX

About The Position

HMG Healthcare, a leader in the Skilled Nursing / Long Term Care industry is currently seeking a qualified Director of Case Management to join our team of energetic, dedicated professionals.

Requirements

Must possess a current, unencumbered, active license to practice as an LVN or RN in Texas. PT/ST license also accepted.
Has extensive knowledge of managed care plans and contracts.
Demonstrate the knowledge and skills necessary to provide support to facility teams and be the example of teamwork and team concept.
Must also possess the ability to plan, organize, develop, implement, and interpret key programs, goals and objectives that are necessary for growth and continued relationships of managed care partnerships.
Understands That Travel is Required 75%

Responsibilities

Auditing/Monitoring managed care plans
Reimbursement
Concurrent Reviews
JOC
Develop and straighten key relationships with managed care support team
Provide oversite and direction to facility teams
Ensuring rehab utilization is according to our contracted level – with VP of Rehab
Assist central billing office with issue when needed
Provides clinical guidance and supervision for manage care programs based on contract language
Provides clinical perspective and best practices to staff through one-on-one coaching, group interaction at case conferences, in-service training, and other team meetings.
Monitors activities to evaluate the productivity and quality of programs and processes to identify potential improvements and to ensure maximum performance.
Manages and participates in departmental projects, workflow processes, policies and procedures in collaboration with internal and external stakeholders.
Develops and maintains professional networks and individual relationships with managed care plans, case managers, and utilization reviewers to promote continuity and quality of care.
Collaborates with staff and leadership to develop and implement systems that support operations and business goals within identified areas of responsibility.
Uses a collaborative approach with the reimbursement team and utilization management to revise, develop, and implement cost savings methodologies and interventions.
Ensures that policies and procedures are developed and enforced in alignment with the standards of patient care and regulatory bodies and that the core components of the case management process are followed.
Serve as point of contact for managed care grievance-related issues in your region
Performs other duties as needed and assigned by the Vice President of Network Development and the Chief Strategy Officer relevant to Case Management activities.